The Awkward Part of Doctors Visits

July 23rd 2016

In the second episode of season one of HBO's "Girls," Lena Dunham's character criticizes a nurse for weighing her with her clothes on, as she would weigh less in the nude.

"That was a rude thing to do," she jokes.

The scene uses humor to illustrate the discomfort some experience during routine doctor visits.

Healthcare professionals check a patient's vitals before the start of every appointment, and stepping on the scale is often part of that process. For people with body image issues or weight problems, however, getting weighed can lead to unpleasant experiences and conversations with the doctor. In 2014, writer S.E. Smith wrote a piece for xoJane about feeling weight shamed by a doctor after she increased in weight from 180 pounds to just over 200 pounds:

"I really do like her except for the fat-shaming thing, and I know that if I switch doctors, I'm going to encounter the same attitude, because this is the predominant attitude in medical settings. But at the same time, I'm afraid to go back to the doctor, because I don't want to be hassled about my weight again, and being afraid of doctors is not a good thing for people with chronic health conditions who need regular medical attention."

As Smith noted, this can discourage people from seeing the doctor, but doctors, of course, don't usually mean to offend patients by mentioning weight. Medical professionals are understandably trying to identify and address potential health issues in patients, and some conditions can best be improved by weight loss.

ATTN: recently asked Dr. Rose Taroyan, an assistant professor of clinical family medicine at the Keck School of Medicine at the University of Southern California, about how to broach the subject of weight with patients in a manner that doesn't alienate them or discourage them from seeking medical help in the future. Here is what she told us via email.

ATTN: Do you have any best practices for talking to patients about noticeable weight gain or loss?

RT: I usually start the conversation with: 'Mr. or Mrs. X, your BMI, which is your weight divided by your height squared is _ , above the healthy range, which means your excess weight can put you at increased risk for future health problems. Would you mind if we talked about it? Tell me about your diet? What does healthy eating mean to you? Do you participate in any physical activity and how much physical activity do you think you should be doing a week to maintain a healthy weight?'

[During subsequent] visits, I tend to praise my patients to boost self-esteem and keep them motivated to help inspire to maintain new behaviors.

ATTN: Where is the line between asking about a patient's drastic weight change to determine potential related health issues (i.e. thyroid problems) and making the patient feel self-conscious about this shift?

RT: Weight changes (gain or loss) can be related to an underlying medical condition. I will ask the patient about any family history of medical problems such as thyroid or high cholesterol and suggest we run some tests to make sure he or she don’t have any of those medical problems. When medical conditions are ruled out, then we discuss it more with open-ended questions: What are your goals regarding your weight? How can I help you carry out those set goals? Are you interested in a weight-loss program or a registered dietitian who focuses on weight control?

ATTN: Do you have advice for someone who might be too afraid to see their doctor again because he/she has had a drastic weight change and is unsure of how the medical professional will react to it?

RT: Please make sure to be evaluated by a provider to rule out any underlying medical problems. During the clinical encounter, the provider will discuss comprehensive lifestyle intervention (modified diet, physical activity and behavior modification) in reducing body weight to lower [morbidity and mortality]. Most medical professionals are available to identify and review realistic weight loss goals with the patient and provide counseling on long term lifestyle changes, including modifying eating behavior by monitoring food intake, increasing physical activity and controlling cues in the environment.

ATTN: Do you have any advice for patients who feel like their doctor may have been condescending or unkind to them about their weight? Should this person confront their doctor about it or possibly find another health professional?

RT: I think weight is very a sensitive discussion topic. It’s hard for most providers to address the concern. If you think you have been insulted by your provider, ask yourself what was it that the provider said that insulted you? Was it an observational comment (provider was stating facts) or judgment commentary?

If you feel like the provider was being judgmental, then the patient-doctor relationship was not established from the first encounter. I would say be honest with your provider. If the provider says something that you take personally, seek clarification but not in a confrontational manner. Patient-doctor relationships are very crucial for compliance and lifestyle changes. Your doctor’s office should be a place to voice all your concerns without fear of judgment. If your concerns are not addressed and you observe [a] lack of respect, I would recommend searching for another provider who meets your needs.

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